Provider Demographics
NPI:1275835167
Name:CASTELLO, ANNE M (BCBA, MED, BCBA)
Entity Type:Individual
Prefix:MRS
First Name:ANNE
Middle Name:M
Last Name:CASTELLO
Suffix:
Gender:F
Credentials:BCBA, MED, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1071
Mailing Address - Street 2:
Mailing Address - City:HEREFORD
Mailing Address - State:AZ
Mailing Address - Zip Code:85615-1071
Mailing Address - Country:US
Mailing Address - Phone:520-678-5336
Mailing Address - Fax:520-366-5923
Practice Address - Street 1:9345 S. REYNOLDS RD.
Practice Address - Street 2:
Practice Address - City:HEREFORD
Practice Address - State:AZ
Practice Address - Zip Code:85615
Practice Address - Country:US
Practice Address - Phone:520-678-5336
Practice Address - Fax:520-366-5923
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-26
Last Update Date:2015-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1-10-7694103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst